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16 — 17372-1 OPO 



The Reduction in Mortality 

Among Colored 

Policyholders 



An Address Delivered before the Annuai, ConferBNCB op 

THS NationaIv Urban I/Eague;, Newark, 

New Jersey, October 21, 1920 



/ BY 

LOUIS I. DUBLIN, Ph.D., Statistician 

Metropolitan Life Insurance Company, New York 

1920 









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THE REDUCTION IN MORTALITY AMONG 
COLORED POLICYHOLDERS.* 



consider health the outstanding problem which today con- 
fronts the colored people. Health is fundamental to well- 
being. No race can possibly be well off if it is seriously 
affected by disease, and if its members suffer from premature 
death. No people can progress economically or spiritually if 
they are constantly handicapped through poor health. 

There are more than 11,000,000 colored people in the 
United States. Of this number, one and three-fourths millions 
or about one-sixth are policyholders in the Metropolitan Life 
Insurance Company. These colored policyholders live in every 
state of the Union. They include both sexes and adults as 
well as children. All occupations are represented, the farmer 
as well as the city worker. We consider our colored policy- 
holders a very good cross section of this group of the popu- 
lation. 

The Company is in a particularly advantageous position to 
know the facts of the present status of health of the colored 
people. In fact, we know at the close of each month the 
essential statistics of mortality among the white as well as 
among the colored policyholders. From figures extending 
over many years, we know that the death rate of colored per- 
sons is about 60 per cent, in excess of that for our white 
Industrial policyholders. The death rate varies somewhat 
from place to place; but, taking the country as a whole, this 
is about the proportion of the respective mortality ratios of 
the two races. The death rate of white policyholders is about 
10 per thousand, and that of the group of insured negroes 
about 16 per thousand. The average length of life of a white 



* A report of an address delivered before the Annual Conference of 
the National Urban League, Newark, New Jersey, October 21, 1920. 



\ ■ )) 



male in the Industrial Department is 46 years ; that of a white 
female, 52 years. The colored male has an expectation of 
only 37 years, a colored female only 39 years. 

It is inevitable that serious consequences should follow 
from these bare facts. But, these facts will be more clearly 
understood as we indicate the particular diseases and condi- 
tions causing these excessive r^tes of mortality. 

Tuberculosis of the lungs is the most important cause of 
death among colored people. The death rate is more than 
twice as high among insured negroes as among white policy- 
holders. The disease is a veritable scourge among young 
negroes. At the ages between 10 and 14 years, the tuber- 
culosis death rate among colored boys is eleven times as high 
as it is among white boys of the same ages. Colored girls 
at the same age period show a tuberculosis death rate eight 
times greater than that of white girls. Tuberculosis is pre- 
eminently a disease of young persons, but it is especially so 
among colored people. In fact, the great excess of tuber- 
culosis mortality among negroes is almost entirely limited to 
the early years of life. After age 35, there is not much dif- 
ference in the effect of the disease in the two races. The dis- 
sease runs a more rapid course among negroes, perhaps, 
because the power of resistance to the disease is much lower 
among these people than among the whites. More than five 
years could be added to the life span of colored people if 
tuberculosis were brought under control. 

Other diseases and conditions are also very prevalent 
among negroes. Malaria, typhoid fever, syphilis, hookworm 
infection, have particularly high sickness and death rates among 
negroes. Whether we look at the records of the draft exami- 
nations, or the figures of mortality among the policyholders 
of the Metropolitan, we find the same fact in evidence, namely, 
very much higher rates among colored persons from those 
diseases and conditions which reflect the sanitary conditions 
of their environment. It is very likely that this fact is partly 
responsible for the high tuberculosis rate among them; for 
such diseases as malaria, typhoid fever, and the others named 
help to break down the resistance of the body and make it an 
easier victim of the tubercle bacillus. 



The death rates from the chronic diseases which are par- 
ticularly prevalent at the older ages, such as organic heart 
disease and Bright's disease are also excessive among negroes. 
These, perhaps, reflect lower standards of personal hygiene 
among the mass of negro wage-earners in the United States 
and also the effects of the infectious diseases so prevalent at 
the younger ages. 

Infant mortality is also a serious problem among colored 
people. In some cities, the death rate is as high as 200 infant 
deaths per 1,000 colored births. And, the mortality of negro 
mothers in child-birth is also much above that of white women. 
No group of people can afford to be indifferent to the proper 
care of women in child-birth and to the preservation of infant 
life. 

Another condition producing excessive mortality among 
negroes is homicide. The crime of homicide has assumed 
alarming proportions among the colored male population of 
the United States. From 15 to 35 years of age, negro males 
have a rate approximately ten times that of white males. At 
these ages, homicide ranks third as a cause of death, being 
exceeded only by the figures for tuberculosis and the acute 
respiratory diseases. 

But, now let me tell you what the Metropolitan has en- 
deavored to do in order to reduce the high mortality from 
these several causes of death. More than ten years ago, the 
Company decided upon a programme of life conservation, 
and this programme was planned for its members, irrespective 
of race. Ten years ago the Executive of the Company said 
that it was the business of life insurance companies not only 
to solicit for insurance, to collect premiums and to pay death 
claims, but to do everything possible to improve the health of 
policyholders and thus to prevent death. I shall show you 
that this was based upon sound reasoning. The results of the 
past ten years indicate clearly the wisdom of the programme of 
health education, of nursing, and of co-operation with the 
life conservation and public health activities of the municipal, 
state and Federal governments. 

Please understand that life insurance companies are, and 
should be, very different from most commercial organizations. 



In ordinary commercial pursuits, it is not difficult to draw the 
line between the interests of a company and those of its cus- 
tomers or patrons. In life insurance it is not possible to dis- 
tinguish between the policyholder and the company, because 
the company represents nothing more than the aggregate of 
these people who have been brought togther for mutual protec- 
tion and advancement. It is true that if you prevent death 
you increase the funds of the life insurance company tem- 
porarily, but this increase is eventually returned to the policy- 
holder. You must remember also that such health work may 
add two to three years to the average lifetime which each indi- 
vidual policyholder may expect. No person in his right mind 
would prefer to have a death claim paid on his life to paying 
two or three additional premiums to the company. 

The question that presented itself to the Executive of the 
Company was : Is death preventable ? Can life be conserved ? 
For twenty years or more the whole public health problem of 
the country had been based upon the thought that there was 
very much preventable sickness and death. Some students 
have said that as many as one-half the deaths occurring could 
be postponed for many years. They have concluded that it is 
primarily a question of funds and of proceeding along the ^ 
right lines. 

The first thing Dr. Frankel, the Third Vice-President 
who directs the Welfare work, did in developing the Com- 
pany's programme of life conservation was to analyze the 
factors that go into preventable death. He found that a great 
many of our policyholders, died because of the lack of ade- 
quate care in sickness. A free nursing service to the sick was 
accordingly established. The experiment of nursing was first 
conducted in New York City, and it was afterward rapidly 
extended to nearly all the Company's Industrial policyholders. 
At the present time, wherever it is practicable to install such 
service, every policyholder may receive nursing care in acute 
illness. Last year, this service made nearly one and one-half 
million visits to 300,000 sick policyholders. We find that col- 
ored policyholders are especially appreciative of this phase of 
the Company's health work. About 13 per cent, of the Nursing 
Service is extended to colored people, and this is a little 



higher than the proportion of such persons insured in the 
Industrial Department of the Company. 

The next' step was to organize the work of instructing 
poHcyholders in hygiene. This was done through the distri- 
bution of leaflets describing the various diseases, their causes 
and their prevention. Our first publication was a leaflet, 
entitled "War on Consumption." More than seven milhon 
copies of this pamphlet have been distributed during the past 
ten years. Over two hundred million copies of the Company's 
educational literature on preventable disease have been distri- 
buted. They are written simply, and in many cases are illu- 
strated. Whenever there is an epidemic of disease prevalent 
in a community, our agents place this literature in the homes 
of the policyholders. It is often possible to spread this infor- 
mation on the prevention of disease where we anticipate an 
epidemic. I refer particularly to smallpox, in which case, 
we send out our leaflets on vaccination. We have a popular 
booklet, entitled "The Child," which is distributed in families 
where there are young children.. This leaflet has been instru- 
mental in instructing mothers in the proper care of children 
and has produced valuable results. 

Our Company has taken account also of the broader aspects 
of disease prevention. Wherever possible, we have assisted 
the authorities to obtain larger appropriations for health work 
in order to permit them to carry out more intensive preventive 
measures. The Welfare Division holds many exhibits each 
year at State and County Fairs. In this way, whole com- 
munities are informed of the importance of good health work 
and of the need of adequately supporting the same. Recently 
the Company launched a campaign on the Pacific Coast in 
order to aid the local authorities to defeat a movement which 
was aimed at the impairment of health departments. The 
opponents of health work in California and Oregon attempted 
no less than to take away the police power from the health 
authorities. We were determined not to permit such a thing 
to be done, and arranged at once to have the many hundred 
agents go into the homes of the policyholders and others to 
inform them of the impending danger. We believe that the 
-campaign will help to defeat these undesi-mble measures. 



You will wish to know whether our health activities have 
brought about the results we expected. Ten years have passed 
and we ought certainly to know some of the results. I am 
able to give you a very encouraging report. During the nine 
years, 1911 to 1919, the death rate among white policyholders 
has been decreased 16 per cent., and among colored policy- 
holders, 9 per cent. The typhoid fever death rate was two- 
thirds lower in 1919 than in 1911. The acute infectious dis- 
eases of children showed a death rate 46 per cent, lower 
among white lives and 63 per cent, lower among colored lives. 
The tuberculosis death rate is 32 per cent, lower among white 
lives and 22 per cent, lower among colored policyholders. The 
death rate from child-birth fever has also been reduced ma- 
terially. In fact, if the death rate of 1911 had continued 
during 1919, we should have paid claims on 27,000 more 
deaths than we actually did. Even if only half of this gain 
was due to the Company's health work, the saving is still an 
enormous one and more than justifies the decision of the 
Executive of the Company. The work that has been carried 
out has demonstrated that life can be prolonged through very 
simple measures which can be undertaken anywhere by munici- 
palities and by the insurance companies. 

There is great need for a wider extension of the work I 
have described among colored people. The colored people 
can profit more from conservation work than any other race. 
The same need for health education and for thejcare of the sick 
exists among those colored people who are not insured in the 
Metropolitan as among those who are policyholders. As I 
told you before, we have only one in every six in the colored 
population insured in our Company. There are the remaining 
five-sixths who ought to be insured and who ought to benefit 
from such health work. I wish to say to those here who repre- 
sent life insurance companies operating among the colored peo- 
ple that they, too, can launch programmes like ours and do so 
with the assurance that the work will pay. If properly carried 
out, the saving in death claims will soon be as large, if not 

6 



larger, than the amount expended for life conservation. I look 
forward to the day when all life insurance companies will do 
this sort of work with little hesitation. It is inconceivable that 
the life insurance business of the future will be carried on as a 
matter of finance only. It must be conducted as a large 
humanitarian effort in which the saving of life is an integral 
part of the business. No other organizations have the same 
opportunity as the life insurance companies. I hope it will 
not be long before all will recognize this fact. 



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